With the adoption of cloud and big data technologies, healthcare organizations are in a position to begin experimenting with IoT. Ranging from home care to smart facilities, there are many ways in which provider organizations can benefit by using IoT in their patient care workflows. E.g., a mobile app with patient geo-fencing capabilities can help optimize physician rounds by dynamically routing the physician to the nearest patient Payers can leverage insights generated by IoT infrastructure to improve population health, increase patient awareness and reduce healthcare costs. Payers can also design more effective reward and retention programs using IoT generated data. As IoT is evolving, adoption is slow but steady, and investments are being made by both startups and industry leaders. Healthcare is among the top 5 industries investing in IoT. This document discusses how IoT can be leveraged to drive efficiency in healthcare workflows and enhance clinical outcomes.

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CitiusTech Thought
Leadership
10 January, 2018 | Author: Mahesh Dedhia | Sr. Project Manager
Improving Efficiency and Outcomes in
Healthcare using Internet of Things
CitiusTech Thought
Leadership

2. 2
Overview
 As healthcare organizations strive to optimize their workflows and improve outcomes, they
seek new avenues that can help them overcome the inefficiencies in their current systems and
thereby extract more ROI. The key to achieve this depends on how well the providers and
payers connect with the patients to provide timely treatment and preventive care. ‘Internet of
Things’ has the potential to transform the way care is delivered, without having the patients to
step outside the comfort of their homes
 With the adoption of cloud and big data technologies, healthcare organizations are in a
position to begin experimenting with IoT. Ranging from home care to smart facilities, there are
many ways in which provider organizations can benefit by using IoT in their patient care
workflows. E.g., a mobile app with patient geo-fencing capabilities can help optimize physician
rounds by dynamically routing the physician to the nearest patient
 Payers can leverage insights generated by IoT infrastructure to improve population health,
increase patient awareness and reduce healthcare costs. Payers can also design more effective
reward and retention programs using IoT generated data.
 As IoT is evolving, adoption is slow but steady, and investments are being made by both
startups and industry leaders. Healthcare is among the top 5 industries investing in IoT.
 This document discusses how IoT can be leveraged to drive efficiencies in healthcare
workflows and enhance clinical outcomes.

3. 3
Agenda
 Introduction to Internet of Things
 IoT: Recent Trends and Forecasts
 IoT: Use Cases in Healthcare
 IoT: Solutions in the Healthcare Provider and Payer Space
 IoT: Adoption Challenges in Healthcare
 Innovation Framework for Healthcare IoT Solutions
 Technology Considerations while Designing IoT Solutions
 IoT: Security and IoT Analytics
 IoT: Standards and Regulations
 Key Takeaways
 References

4. 4
Introduction to Internet of Things
The Internet of Things (IoT) is the network of physical objects or things embedded with electronics,
ubiquitous sensors, software and internet connectivity enabling it to achieve greater value and
service by exchanging data. Each thing is uniquely identifiable through its embedded computing
system and interoperable within the existing internet infrastructure.
IoT technology innovation plays a key role in connecting people around the world using healthcare
applications and intelligent sensor network, collectively referred to as “Internet of Healthy Things”.
Coke started sending
messages about the
availability of a coke
can using internet
1982
1999
2000
2003
2008
Current
Massachusetts Institute of
Technology (MIT)’s Auto-ID
Centre presented the
concept of IoT
RFID deployed by US
Department of Defence in their
Savi program and by Walmart in
the commercial world
Increasing
investments in
IoT across
industries
MIT Auto ID Centre developed
EPC, a global RFID-based item
identification system intended to
replace the UPC bar code
U.S. National Intelligence
Council listed the IoT as
one of the six ‘Disruptive
Civil Technologies’

5. 5
 Commercial IoT platforms such as Microsoft IoT
Hub, IBM Bluemix, PTC ThingWorx, AWS IoT as
well as open source IoT platforms like Kaa, GE
Predix and DeviceHive continue to invest and
innovate with IoT service offerings including
secure messaging and device management
 Hardware manufacturers like Cisco, Dell and
Intel are investing in enhancing IoT gateways to
support fog computing
 Startups continue to invest and innovate in
wearable and implant technologies to monitor
stress levels, glucose levels for Type 1 diabetes
patients and even predict seizures for epileptic
patients
 IoT security remains a top concern for IoT
solution providers as well as consumers, given
the prediction of billions of connected devices
and their limited processing capabilities to
counter security attacks
IoT: Recent Trends and Forecasts
Industry Forecast
 $6 trillion to be spent on IoT solutions
in the next 5 years
 34 billion devices to be connected to
internet by 2020
 646 million devices to be used for
healthcare by 2020
 IoT healthcare market will grow at
17.7% CAGR globally during 2017-
2022 with US leading at 78% market
share
 McKinsey Global Institute puts the
value potential of IOT in healthcare
market at $170B - 1.6T by 2025
Sources:
BusinessInsider.com
Report buyer

6. 6
Patients
IoT: Use Cases in Healthcare
 Health Monitoring  Geo-fencing
 Fitness Tracking  Improved drug administration
Clinical
 Integrated Devices for
Coordinated Care
 Accountable care
through predictive
analytics
Operational
 Improved Device Design
 Predictive Maintenance
 Remote Upgradation
 Real-time access to
patient data
 Smart Facilities
 Remote Patient
Monitoring
 Improved record-
keeping of patient
encounters
 Dynamic scheduling
of physician rounds
 Population Health
Management –
Epidemic Detection
 Predictive analytics on
IoT device data
 Reward & Retention
Programs for health-
conscious customers
 Improved plan design
by leveraging IoT data
 Healthcare Workflow
Automation
 Improved inventory
management
 Collecting PHI
through wearables
and consumables
 M2M integration in
supply chain
automation
Healthcare Providers Health Plans and Payers Medical Technology Life Sciences and Pharma

7. 7
IoT: Solutions in Healthcare Provider Space
Benefits of IoT-enabled Solutions Technology Enablers
Smart
Facilities
 Embedded sensors in infrastructure (lobbies,
floors, etc.) can enable tracking of patient
location and wireless monitoring of vitals in
intensive care units
 Sensor network inside hospital building
enables staff / equipment scheduling,
monitoring of prescription drug inventory
 Network of location transmitters enable
indoor navigation, tracking of location and
activities where clinicians spend their time
 IoT enabled sensors (RFID, NFC, BLE)
 IoT gateways with encryption
capabilities
 Device management software
 Cloud-based/on-premises data
aggregation and analytics engine
 Mobile app for tracking, alerts and
secure messaging
Incorporating
Patient-
generated
Data
 Patient-generated health data collected
passively by IoT devices has the potential to
fill in the blanks in electronic health record
systems (EHR) and used to generate
documentation of a specific episode of care
 Audio-video conferencing solution using
smart phones enables incorporating the
patient’s voice from telephonic consultation
into the EHR
 Custom-made wellness tracking
devices and implants
 Audio-Video conferencing and
Recording solution
 IoT Gateways supporting HL7 based
integration with EHRs
 Encryption and authentication
support
 Scalable storage with support for
multimedia data

8. 8
IoT: Solutions in Healthcare Payer Space
Benefits of IoT-enabled Solution Technology Enablers
Population
Health
 Collecting population health data through payer-
supplied or third-party consumer devices, such
as activity monitors and vital signs measuring
devices for predicting trends
 Improving urban healthcare with the predictive
analytics based on regional epidemic data
generated through IoT infrastructure
 Consumer health & fitness
tracking devices
 IoT gateways with deidentification
and encryption capabilities
 Device management software
 Scalable NoSQL storage
 Cloud-based/on-premises data
aggregation and analytics engine
 Mobile app for tracking, alerts
and secure messaging
 Identity server for authentication
and access control
Incorporating
Patient-
generated
Data
 Analyzing patient lifestyle provides continuous
feedback with notifications and reminders to
promote lifestyle modification based on real-
time health data analytics on real-time health
 Consumer health monitoring devices that can
transmit data over the internet, enable greater
degree of preventive and remote care, especially
for seniors and patients with chronic diseases

9. 9
IoT: Adoption Challenges in Healthcare
Key challenges for Healthcare CIOs Key concerns to IoT adoption
Consumer
IoT
 Integration of consumer wearables, with
enterprise health data
 Manage and secure user to device mapping
 Analyze huge volume of data
 Share healthcare data
 Time to market, multiple device support
 Variety of devices/sensors
 Enterprise integration
 Identity and access management
 Security and privacy
 Data portability
 Standards Compliance
Enterprise
IoT
 Older equipment/devices with incompatible
protocols and mode of communication (PSTN)
 Lack of data portability from device to EDW –
often unstructured or proprietary data formats
 Security by obscurity
 Speed of deployment and portability
Applicability of generic frameworks to
healthcare
Enterprise integration
Identity and access management
Security and privacy
Data portability
Standards compliance
Infrastructure costs and maintenance

10. 10
Innovation Framework for Healthcare IoT Solutions
Structured and
Unstructured Data
Heart rate, Respiration, etc.Clinical Data
Alerts, Notifications Recommendations
Data Mining Predictive Analysis Deep Dive
Device failure
Patterns
Diagnosis
Effectiveness
Environmental effects
on Population Health
Device Utilization
Patterns
Remote
Patient
Monitoring
Population
Health
Management
Vulnerability
study
Processed and
Transformed Data
Non-clinical and
Clinical Data
Integrated
Device for
Coordinated Care
Non-clinical Data
Meaningful Data
Cognitive
HIS /RIS
Improved
Device
Design
Remote
Upgradation
Predictive
Maintenance
Clinical Data Operational Data
Location data, Device
specific Events & Failures
Communication
& Aggregation
Sensor-based
Devices
Intelligence
Innovation
Parsing, De-Identification,
Aggregation & Processing

11. 11
Component Design Considerations
Nodes
(Edge
Devices)
 Devices with required sensors, cache,
processing power and battery capacity
 Supported connectivity protocols: TCP/IP,
WiFi & BLE
IoT Gateways  Secure data exchange between nodes & app
server
 Supported operating systems
 Message filtering and aggregation
capabilities
 Programmability requirements, Local
storage capacity and Device management
Protocols for
Connectivity
 Node – Gateway: RFID, NFC, BLE, Zigbee, Z-
Wave, Gateway – App Server: Wifi, Ethernet,
Cellular
IoT Platform  Supported communication protocols
 Device management
 Secure messaging through HTTP, MQTT,
CoAP, etc.
 Support for popular IoT devices
Technology Considerations while Designing IoT Solutions (1/2)
Key Decision Making Criteria
while Designing IoT Solutions
 Interfacing requirements
with third party
hardware
 Predicting the data
traffic/volume
 Setting performance
benchmarks
 Security mechanisms
built into the software
platform

12. 12
Component Design Considerations
Storage  For Nodes: Flash drives, cards and solid
state drives
 For App Server/Cloud – Object storage
solutions, public cloud storage,
SQL/NoSQL databases
Device
Management
Software
 Secure provisioning and decommissioning
of devices
 Automated and remote management
 Ability to accommodate large variety of
devices
 Remote & bulk updates, failure detection,
automated recovery
Note: Choice of connectivity model – device to device v/s device to app server v/s device to gateway
– influences the components and their capability requirements while designing IoT architecture
Technology Considerations while Designing IoT Solutions (2/2)
Key Decision Making Criteria
while Designing IoT Solutions
 Maturity and industry
adoption of the tools and
platforms
 Standards and regulatory
compliances to adhere
 Technical skillset at
disposal

13. 13
IoT: Security (1/2)
Tools for Securing IoT
Solutions
 Device level security
through secure booting,
integrated crypto keys
using Trusted Platform
Modules (TPMs) and
physical protection
 Secure provisioning,
identification and
decommissioning of
devices
 De-identification of
Personally Identifiable
Information (PII)
 End to end security using
SSL certificates and TLS
 Firewalls and intrusion
prevention systems
 Laying out an extensive and powerful infrastructure for
Internet of Things comes with inevitable security issues that
need careful analysis and risk evaluation
 The Dyn DDoS attack caused by Mirai malware in Oct 2016,
involving up to 100,000 endpoints reinforces the
vulnerability and importance of security measures required
for IoT solutions
 Security design principles should be rigorously implemented
to fortify the solution end to end, such as:
• Use Virtual Private Networks (VPNs) to access edge
devices
• Initiate connection from edge device to the cloud, and
not the other way round
• Allow file transfer only in one direction, if not required in
both the directions
• Double-encrypt messages with sensitive data
• Restrict access to messages that can control the device
remotely
• Implement thorough instrumentation to allow remote
monitoring of the activity

14. 14
IoT: Security (2/2)
The EU’s General Data Protection Regulation (GDPR) will apply to IoT solutions, which mandates
aspects such as:
 Reporting of any personal data breach within 72 hours
 User’s consent for processing their data
 User’s rights for data portability and objecting to automated decision making
 Prohibition for children under 13 to provide consent for processing of their data, on their
own

15. 15
IoT: Analytics (1/2)
 IoT business models will exploit the information collected by edge devices in many ways – for
example, to understand customer behavior, to deliver services, to improve products, and to
identify and intercept business moments.
 With the unprecedented amount of data that will be generated by these edge devices, aspects
such as storage, ownership and expiry of data becomes critical.
Choosing the right Cloud platform
Most of the cloud providers have storage and analytics offerings. Having IoT platform, storage and
analytics engine on the same cloud greatly simplifies the solution design and maintenance. Keep
in mind that since most of the IoT workflows are event driven, event processing and real-time
analytics capabilities are key features for high-volume IoT solutions.
Key Considerations
Storage v/s Streaming
Managing the data generated by billions of devices will be a significant challenge to address
during infrastructure and architecture planning. Even though cloud infrastructure will scale to
accommodate large volumes of data, it may not be effective to store all the data traffic. IoT
architectures need to evolve to perform real-time analytics on the streaming data and store only
the results, as necessary.

16. 16
IoT: Analytics (2/2)
Distributed Analytics
As another design alternative, distributing the data analytics between the cloud, gateways and
edge devices may result in optimizations at different levels, such as reduced storage needs and
reduced network traffic. The aggregation and filtering that happens as part of the analytics
reduces PII being transmitted over the network. As a by-product, it also reduces battery
consumption of edge devices that would be used in wireless transmissions.
Ownership of Data
With increasingly vast network of sensors, IoT solutions will be able to gather tons of health,
location and activity data. IoT solution providers will need to deal with this data with great care
and consumers’ consent. Adoption of IoT will only add fuel to the discussion of ownership of data
that started with the adoption of big data in healthcare.

17. 17
IoT: Standards and Regulations (1/2)
Implementation of an IoT solution involves a range of technologies. As multiple IoT solutions
converge together, it will be instrumental for these solutions developed by different companies
and service providers to be compatible with each other to enable reusability of infrastructure and
insights gained through the collected data.
As with any industry, standardization will bring multitude of technological and commercial
benefits:
 Standardized hardware specifications will enable mass-production of edge devices that can
operate in different geographies
 Standardized communication protocols will enable smoother integrations and reduce the
efforts spent in working around the compatibility issues
 As technologies are standardized, business models benefit from and evolve around the APIs
based on these standards
 Governments and regulatory bodies define compliance rules around these standards, which in
turn enables manufacturers and service providers to cater to larger consumer-base across
geographies

18. 18
IoT: Standards and Regulations (2/2)
Areas of Standardization
 Connectivity protocols for nodes and gateways – TCP/IP, Wifi, Ethernet and Cellular
protocols are well established in this space. In addition, BLE and Zigbee have emerged as
lightweight and low-power alternatives
 Messaging standards – Even though HTTP is leading this front, for dealing with hardware
with lower capacity and compute powers, lightweight protocols like MQTT, CoAP and AMQP
are developed with IoT scenarios in perspective. These standards provide improved latency,
assure different levels of Quality of Service to suit the needs and consume less power
 Security standards – Security measures for hardware as well as data protection at various
layers in the IoT solution are yet to mature
 Regulatory requirements – Industry-specific regulations will evolve over time. Federal
regulatory agencies like ONC and HHS in USA will play key role in protecting the consumers
from any misuse of data

19. 19
Key Takeaways
 Internet of Things has a lot of potential to improvise and automate existing
processes and workflows across multiple industries and healthcare
organizations are certain to be amongst the beneficiaries
 A lot of work needs to happen in terms of establishing regulations and
addressing security concerns. While these are difficult problems to solve,
industries and governments together can bolster this space by leveraging
knowledge and experiences in similar spaces
 Increasing investments and maturity in technology areas such as Cloud,
advancements in compact and smart devices, large-scale storage solutions and
wireless communication, have given IoT solutions a real shot in the arm
 On the other hand, advanced analytics and machine learning technologies are
evolving at a rapid pace to be able to consume the voluminous data that IoT
solutions can generate
 With the right ingredients in place, these are exciting times for innovators and
businesses to be a part of the IoT wave

20. 20
References
 Internet of Things – Wikipedia
 Internet of Things for Provider Organizations
 Population Health Use Cases for Internet of Things
 Understanding IoT Security
 Top 10 Internet of Things (IoT) Technologies for 2017 and 2018
 IoT: Vision, Architectural Elements and Future Directions
 IoT Developer Survey 2017

21. 21
Thank You
Authors:
Mahesh Dedhia
Sr. Project Manager
thoughtleaders@citiustech.com
About CitiusTech
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